What is the clinical evidence from this study?

Study design: Cohort. Population: Acute coronary syndrome (n=14214). Intervention: Elevated post-procedural high-sensitivity troponin T (≥0.5 ng/mL) vs. hs-TnT <0.5 ng/mL. Primary outcome: All-cause mortality at 12 months (female cohort) (aHR 2.83, 95% CI 1.56-5.13, p=<0.001).

What does this research mean for the field?

The prognostic impact of elevated post-procedural high-sensitivity cardiac troponin T on 12-month mortality is substantially greater in female ACS patients than in males, exhibiting a non-linear dose-response relationship in females compared to a linear one in males. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This study aimed to determine if the relationship between elevated high-sensitivity troponin T and mortality after PCI varies by sex.

June 9, 2026Open Access

Sex-specific non-linear association between post-procedural high-sensitivity troponin t and 12-month mortality after PCI: insights from a prospective large-scale registry

Q: What are the key findings of this study?

Elevated post-procedural high-sensitivity troponin T was associated with increased 12-month mortality, with a significantly stronger association in females (aHR 2.83) than in males (aHR 1.63).

Q: What does this research mean for the field?

The prognostic impact of elevated post-procedural high-sensitivity cardiac troponin T on 12-month mortality is substantially greater in female ACS patients than in males, exhibiting a non-linear dose-response relationship in females compared to a linear one in males. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

This study aimed to determine if the relationship between elevated high-sensitivity troponin T and mortality after PCI varies by sex.

Key Result

Elevated post-procedural high-sensitivity troponin T was associated with increased 12-month mortality, with a significantly stronger association in females (aHR 2.83) than in males (aHR 1.63).

Key Points

This study aimed to determine if the relationship between elevated high-sensitivity troponin T and mortality after PCI varies by sex.
Retrospective analysis of 14,214 ACS patients from a prospective PCI registry from March 2016 to March 2019.
Patients were categorized based on hs-TnT levels measured within 48 hours post-procedure (< 0.5 vs. ≥ 0.5 ng/mL).
Multivariable Cox regression models and restricted cubic spline analyses assessed the association between hs-TnT and mortality outcomes.
Elevated hs-TnT (≥ 0.5 ng/mL) increased 12-month mortality: females (aHR 2.83; 95% CI 1.56–5.13) vs. males (aHR 1.63; 95% CI 1.03–2.58; P for interaction = 0.019).
Nonlinear relationship between hs-TnT and mortality was found in females (P for nonlinearity = 0.01), while it was linear in males (P for nonlinearity = 0.12).
Interaction tests confirmed the disparity between sexes (P = 0.0042).

Study Design

Type

Cohort (n=14,214)

Multicenter

Structured PICO

Does elevated post-procedural hs-TnT increase 12-month mortality in ACS patients undergoing PCI?

Population

14,214 patients with acute coronary syndrome undergoing percutaneous coronary intervention, followed for 12 months.

Exposure

Elevated post-procedural high-sensitivity cardiac troponin T (hs-TnT) ≥ 0.5 ng/mL measured within 48 h after PCI

Comparator

Post-procedural hs-TnT < 0.5 ng/mL

Outcome

All-cause mortality at 12 months after PCIhard clinical

Elevated post-procedural hs-TnT is associated with a substantially greater risk of 12-month mortality in female compared to male ACS patients undergoing PCI, suggesting a need for sex-specific risk stratification.

Main Result

Hazard Ratio: 2.83 (95% CI 1.56–5.13)

Absolute Event Rate: 5.13% vs 1.2%

p-value: p=<0.001

Limitations

Single-center retrospective analysis of an exclusively East Asian cohort, which may limit generalizability
High STEMI prevalence in the elevated hs-TnT group makes it difficult to definitively separate presenting infarct severity from procedural injury
Modest number of female deaths (n=71) may compromise the precision of sex-specific estimates
Post-procedural hs-TnT represents the last recorded value within 48 hours and does not necessarily represent the peak concentration
LVEF data were missing in 15.8% of patients
Restriction to hs-TnT alone precludes a comprehensive multi-biomarker assessment of periprocedural myocardial injury

Abstract

Background Post-procedural high-sensitivity cardiac troponin T (hs-TnT) is an established prognostic marker in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). Current practice applies uniform troponin thresholds regardless of sex, potentially overlooking biological differences in cardiac mass and injury patterns. This study aimed to investigate whether the association between elevated hs-TnT and clinical outcomes differs by sex, and to characterize sex-specific dose–response relationships. Methods This retrospective analysis utilized data from a prospective PCI registry enrolling consecutive ACS patients between March 2016 and March 2019. Patients were stratified by post-procedural hs-TnT concentrations measured within 48 h after PCI (< 0.5 vs. ≥ 0.5 ng/mL). The primary outcome was all-cause mortality at 12 months after PCI. The main secondary outcomes included ischemic events (composite of cardiac death, myocardial infarction, or stroke) at 12 months. Multivariable Cox regression models with sex-by-hs-TnT interaction terms and restricted cubic spline (RCS) analyses were performed. Results Among 14,214 patients (10,416 males, 3,798 females), elevated hs-TnT (≥ 0.5 ng/mL) was associated with increased 12-month mortality in both sexes, with a stronger association in females (aHR 2.83; 95% CI 1.56–5.13) than in males (aHR 1.63; 95% CI 1.03–2.58; P for interaction = 0.019). For cardiac death, similar differences were observed (P for interaction = 0.023). RCS analysis revealed a nonlinear relationship between hs-TnT and mortality in females (P for nonlinearity = 0.01), whereas the relationship was linear in males (P for nonlinearity = 0.12). The formal test of interaction between continuous hs-TnT and sex confirmed this divergence (P = 0.0042). Conclusions The prognostic impact of elevated post-procedural hs-TnT on mortality was substantially greater in female than in male ACS patients. These hypothesis-generating findings suggest that sex-specific approaches to troponin-based risk stratification after PCI warrant further investigation.

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